Miscarriage - Early

Introduction

Early miscarriage in the first trimester of pregnancy is very common. Early miscarriage is the loss of an embryo or fetus before the 20th week of pregnancy. Bleeding with cramps or pain in the lower abdomen is a common sign of miscarriage. You should contact your doctor immediately if you suspect that you are having a miscarriage.

Anatomy

The internal female reproductive system includes the ovaries, fallopian tubes, uterus, cervix, and vagina. The ovaries are two small organs that produce eggs (ova) and hormones. One of the ovaries typically releases one mature egg each month in a process called ovulation. Two fallopian tubes extend from near the ovaries to the uterus. The fallopian tubes transport the mature eggs to the uterus (womb). A sperm cell from a male may enter the fallopian tube from sexual intercourse. The fertilized egg travels to the uterus and implants into the uterine lining.

The fertilized egg develops a placenta to receive nourishment from the mother and an embryonic sac that surrounds the embryo. The embryo develops vital organ systems and grows into a fetus. The fetus continues to develop and increase in size. After about nine months, the baby is born through vaginal birth or cesarean section.

Causes

Early miscarriages are very common and estimated to occur in up to 40-50% of all pregnancies. Early miscarriages occur before the 20th week of pregnancy. Miscarriages that occur after the 20th week are termed late miscarriages. In some cases, miscarriage may occur before a woman knows that she is pregnant. The majority of known early miscarriages occur between the 7th and 12th weeks of pregnancy. In most cases, miscarriage is a random one-time occurrence and most woman experience successful pregnancies in the future. Miscarriage is more common in mothers over the age of 35.

Most early miscarriages occur because of genetic problems, hormone deficiencies, or abnormal immune responses in the embryo. They may also occur because of infection and serious diseases in the mother, such as diabetes or thyroid disease. In many cases, the cause of early miscarriage is unknown. In most cases, the cause of miscarriage is beyond what anyone can cause or control and a woman should understand that a miscarriage is not her fault.

Symptoms

The most common symptoms of miscarriage are bleeding with cramps or pain in the lower abdomen or back. Other symptoms include staining that lasts for three days or more, severe pain for 24 hours or more without bleeding, or heavy bleeding without pain (like a heavy period). You may pass large clots or grayish matter when the miscarriage begins.

Diagnosis

You should contact your doctor if you suspect that you are having a miscarriage. Your doctor may use an ultrasound to see if the fetus is still alive. Blood tests to measure human chorionic gonadotropin (hCG) may be used. Developing embryos produces hCG. HCG levels increase in a predictable manner in healthy pregnancies. These tests may be repeated over days or weeks. Some women, for unknown reasons, bleed during pregnancy and continue on to deliver healthy babies.

If it appears that a miscarriage has occurred or is in progress, your doctor will view your cervix to see if it is dilated or to check for ruptured membranes. An ultrasound is used to see if all of the fetal matter has been expelled. There are different types of miscarriages that may occur, and the treatment that you receive depends on the type of miscarriage that you have.

Spontaneous Abortion

Spontaneous abortion is the medical term for a miscarriage that occurs because of natural events during pregnancy. It does not refer to elective or therapeutic abortion procedures that a woman may choose.

Complete Abortion

A complete abortion means that all of the products of pregnancy, the embryo or fetus, placenta, and sac are expelled from the body.

Incomplete Abortion

An incomplete abortion means that only part of the products of pregnancy is expelled from the body.

Missed Abortion or Missed Miscarriage

A missed abortion occurs when the embryo or fetus dies, but the products of pregnancy do not leave the body.

Threatened Abortion

A threatened abortion means that the symptoms and signs of miscarriage are occurring and that a miscarriage is possible, but it does not mean that one will definitely occur.

Inevitable Abortion

An inevitable abortion means that the symptoms and signs of miscarriage are occurring and that a miscarriage will definitely occur and cannot be stopped.

Treatment

If you are experiencing a threatened miscarriage, your doctor may suggest bed rest and restricted activities, including sexual intercourse. Your doctor will monitor your condition. Some women with a threatened miscarriage proceed with healthy pregnancies, and others experience miscarriage. Unfortunately, there is nothing that can be done to stop an inevitable miscarriage from happening. Some studies have shown some benefit in women with recurrent miscarriages taking high dose folic acid (1000 mcg) seen in newer prenatal vitamins, progesterone vaginal supplementation or even baby aspirin 81mg per day. Unfortunately this data is limited

If you experience a miscarriage, your doctor will perform a pelvic exam and use ultrasound to make sure the miscarriage is complete. If the miscarriage is not complete, options include waiting and monitoring, medication, or surgery. In some cases, doctors may wait a few days to see if spontaneous abortion occurs. Medication may be used to induce spontaneous abortion. A surgery, called dilation and cutterage (D&C) may be used to remove all of the products of pregnancy.

Your menstrual cycle should return a few weeks following a miscarriage or several weeks after a D&C. It is possible to become pregnant immediately. Most doctors recommend waiting one menstrual cycle before trying to become pregnant again.

The loss of a pregnancy can be a very emotional experience for some women, their partners, and their loved ones. It is important to let yourself grieve and surround yourself with positive sources of support. If you have concerns about depression, discuss them with your doctor. Your doctor can refer you to appropriate resources for assistance and support.

Prevention

The risk of miscarriage may be decreased by receiving a prenatal examination prior to becoming pregnant or as soon as you learn that you are pregnant. In many cases systemic diseases can be treated before pregnancy occurs. Couples with a history of repeated miscarriages may benefit from genetic testing and counseling.

Women with recurrent miscarriage (2-3 or more pregnancy losses with no successful pregnancies may have underlying issue that keep interfering with maintaining a pregnancy. There may be structural issues such as polyps, septum or fibroids. There may be underlying thrombophilic disorder that promotes blood clots. Certain medications may be harmful to an early pregnancy. Some medcal conditions like diabetes if not well controlled can also contribute to pregnancy loss. If you have suffered this, make it a point to see an OBGYN doctor or inferility doctor to determine if there is a reversible or treatable cause.

Fortunately/unfortunately miscarriages are a common occurrence even in healthy couples. Not every pregnancy is made by a health ovulated egg or ejaculated sperm. One miscarriage does mean a serious problem is occurring and can occur interspersed with successful completed pregnancies. The fertility rate following a miscarriage is slightly higher. It is important to heal both physically and psychologically from the pregnancy loss so that you can enjoy and be happy when you do become pregnant again.

Am I at Risk

In the majority of cases, a miscarriage occurs because of conditions that are beyond anyone’s control, such as genetic or chromosome causes. However, a few factors may increase the risk of miscarriage including:

_____ The risk of miscarriage is higher for women over the age of 35. The incidence of chromosomal abnormalities is higher as a woman’s eggs increase in age.
_____ Exposure to rubella, radiation, certain chemicals, certain medications, some sexually transmitted diseases, certain infections, smoking, and substance abuse may increase the risk of miscarriage.
_____ Women with a malformed uterus have an increased risk of miscarriage.
_____ Poor nutrition or vitamin deficiency may increase the risk of miscarriage.
_____ Women that have had three or more miscarriages have a higher risk of a future miscarriage.
_____ Hormone insufficiency in the mother increases the risk of miscarriage.
_____ Women with some medical conditions, such as diabetes or thyroid disease may have an increased risk for miscarriage.
_____ Some women have an immune response that causes her body to reject an embryo; however, once identified, such women can receive medications to prevent miscarriage.
_____ In rare cases, genetic conditions in the couple, either the female, male, or both, may cause miscarriage, such as a history of blood clots.

Complications

Complications to the mother from early miscarriage are rare, but in some cases, infection may develop. All of the products of pregnancy must be expelled or removed from the body or else an infection will occur.